Outcome evaluation

Monitoring for successful therapy is critical in this serious infection to prevent complications, prevent resistance development, and decrease mortality. Routine assessment of clinical signs and symptoms, as well as laboratory tests (i.e., repeat blood cultures), microbiologic testing, and serum drug concentrations (if appropriate), must be performed.

Resolution of signs and symptoms typically occurs within a few days to a week in most cases. Monitor the patient daily for febrile episodes, as well as other vital signs, with expected normal values within 2 to 3 days of initiating antimicrobial therapy. Persistent signs or symptoms could be indicative of inadequate treatment or development of resistance.

Blood cultures are the primary laboratory evaluation to assess response to therapy. Typically, with appropriate treatment, they should become negative within 3 to 7 days. Use subsequent blood cultures if the patient appears not to be responding to therapy or on completing treatment to confirm eradication of infection. Evaluate all susceptibility reports to assess antimicrobial therapy.

Additionally, the patient needs to be counseled on the necessity of prophylactic antibiotics prior to major dental treatments (in appropriate patients) in order to prevent recurrent infections. This is critical in patients with risk factors that predispose them to developing IE, such as prosthetic heart valves, other valvular defects, or previous IE.

Develop a follow-up plan to determine whether the patient has achieved a cure, which includes a clinical evaluation of signs/symptoms, repeat blood cultures, and possibly a repeat echocardiogram. The patient should also be assessed for any adverse events. This should be performed usually within a few weeks after the completion of therapy.

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